The Proposed study will examine mental health service use, needs and outcomes of treatment for children from 4 to 17 years of age in the US Commonwealth of Puerto Rico (PR). We offer a conceptual framework which focuses on assessing multiple levels of outcome and provides a guide to integrate epidemiological, utilization and organizational perspectives to study children's mental health. PR is an optimal location for achieving these goals for a number of reasons: boundaries of service systems are defined naturally; different levels of poverty and rural residence y can be studied; a team with a sound epidemiological and health services research history will track children and their families throughout,the longitudinal study; the examination of the family context both as a potential risk and protective as well as an alternative source of care, can be well addressed given the strong family and community supports. Findings thus can contribute to understand the level of family burden when service is provided in the community vs. institutions. The findings can enhance the knowledge about children living in different levels of poverty as well as children living in rural areas in the mainland. The design is based on three probability samples derived from the same units in the island; a sample of organizations (N= 154) from six service sectors (Education, Juvenile Justice, Social Welfare, Primary Health Care, Substance Abuse and Mental Health), a sample of children from these service sectors (N= 1800) and a sample of children from the community (N= 1,800). The survey will obtain information by direct interview with the children and their parents. Information will also be gathered from teachers by telephone interview and from the main provider through self- administered questionnaires. The samples of children in the community and service sectors will be followed with two direct interviews two years apart. Telephone interviews will be done half-way in the intervening period to maintain contact with the sample and obtain information concerning changes in the use of services, symptoms and quality of care. The data will be analyzed in an integrated fashion that ties each child to the family, neighborhood system and the service system. Findings can be generalized to the entire island and permit linkage of child, family, community and service system data, including organizational characteristics o the service systems, to provide a broad picture of the impact of services on children and families in the island.